Yes, this is true -- but as far as I know it doesn't prevent balance billing. All it means is that all emergency care needs to be paid on the same schedule as in-network care.
In other words, if an in-network ER incident would pay out 90% of an allowable amount of $20,000, but you went out of network at a place that bills for $30,000, the insurer will pay $18,000 (90% of their $20K allowance) but you can still be billed the remaining $10K, for a total of $12K instead of $2K.
http://kff.org/private-insurance/st...iders-balance-billing-managed-care-enrollees/
This is the issue. It is the balance billing that is the problem. ER charges can be insane. About a year ago, my daughter went to the urgent care clinic and they referred her to the ER after checking various things, including a negative flu test. I took her an in-network ER (thank goodness). We were there several hours. She never saw a physician (she did a nurse practitioner). After various tests, they decided that she had abdominal pain due to the flu.
The bill was over $20,000. Now, the hospital was in network and they paid a tiny fraction of the bill so it was fine. But, had the hospital been out of network and they agreed this was emergency care (note we
did go to Urgent Care first and they sent us to the ER), the entire balance beyond whatever the insurer wanted to pay could have been billed.
I have read one story total which caused somewhat of a financial ruin and it was not from this site. IIRC it was about a woman on vacation who went into early labor and had some pretty big hospital bills from the local out of network hospital. I think it was on the order of $50k to $100k, which would wipe out most Americans but might be withstood from most on ER.org. IIRC she is fighting the charges too.
So I see it as a valid concern but perhaps not the 'OMG we are all going bankrupt next year' type of concern.
I think in most instances out of network costs won't immediately bankrupt someone. I think the major risk would be someone in an accident and taken to an out of network hospital and the person was not conscious for several days. Even if the insurer paid for the hospital like it was in network, the balance billing could be brutal.
I will say that this year and last year year we have had several instances of out of network providers that we didn't know about. Mostly, it was ER docs or as anesthesiologist or radiologist. It doesn't bankrupt us but it is annoying.
A big issue really is ambulances. They can charge huge amounts and it varies from one ambulance company to another. I saw an ambulance bill that was from a psychiatric hospital transporting someone to ER at another hospital and then there was transport back. One ambulance company going one way was almost double the ambulance company going back. And, the patient has no choice in any of it. And, usually these ambulances are out of network. Maybe the transport to the ER is considered emergency but an insurer might see sending the patient back to the original hospital as a non-covered non-emergency transport. But, the patient actually has no choice in any of this.
Will this bankrupt someone? No. But it could sure be annoying to get a $3000 bill for something where the patient had no choice whatsoever.
The real situations where I could see out of network really bankrupting someone.
1. You think the hospital is in network. You look it up on the website and it says the hospital is in network and you go there and are hospitalized for several days and have major care and it turns out the hospital really wasn't in network. I agree that this isn't real likely, but could happen.
2. The second one is more of a choice but a difficult one. Imagine that you have a life threatening cancer and there is a treatment that is helping you. But, your plan is discontinued at the end of the year and you have to go another plan. The one hospital with that treatment is no longer in network. What do you do?
http://www.houstonchronicle.com/bus...ance-plans-could-devastate-cancer-6603232.php
